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Arrhythmias; heart block Alterations in maternal hemodynamics, effects of maternal medication, and maternal cyanosis all directly affect fetal outcome. Maternal cyanosis is associated with higher incidence of abortion, still birth, and small-for-gestational-age babies. If undetected or unrepaired during childhood, a secundum-type defect is more common that a primum or sinus venous type of defect.
This defect is more common in females, and mitral valve prolapse is often seen. The sinus venous defect is located at the junction between the upper portion of the intraatrial septum and the point of origin of the superior vena cava and commonly is associated with partial anomalous pulmonary venous drainage.
The ostium primum defect usually is detected and closed during childhood; however, after surgery a shunt may persist and often is associated with cleft mitral valve, which can be regurgitant in adults even after valvular repair.
The theoretical risk of an uncorrected atrial septal defect during pregnancy would be volume overload, which would further enlarge the right atrium and ventricle. A woman with an unrepaired atrial septal defect prescribed prolonged bed rest for obstetric reasons requires anticoagulation prophylaxis for deep venous thrombosis, because she is at risk for a paradoxical embolus.
In one study of 80 patients there was a higher incidence of cesarean section and need for medical therapy for women with unreparied atrial septal defects compared with a postoperative population. Pregnancies should be delayed 6 months after the procedure to allow for endothelialization of the device.
Atrial septal defects without associated pulmonary hypotension that have been closed may not constitute a risk to the patient and do not necessitate antibiotic prophylaxis. The risk of atrial arrhythmia may persist despite previous surgery.
Ventricular septal defect The ventricular septal defect is the most common congenital heart disease lesion identified at birth; however, it is less common in adults. The defect may close spontaneously within the first 5 years of life. Uncorrected ventricular septal defects are less often associated with pulmonary hypertension, and other congenital lesions may be present.
The most clinically significant associated defect is aortic regurgitation, in which the aortic leaflet prolapses into a membranous ventricular septal defect in an attempt to close the defect. An indication for closure would be increasing pulmonary artery pressure.
This is a high-risk lesion for endocarditis patients who generally require antibiotic prophylaxis, which is optional for an uncomplicated vaginal delivery. Residual shunting or pulmonary hypertension can be detected on examination and confirmed by Doppler echocardiography during pregnancy.
After surgical closure, pregnancy is not of increased risk if pulmonary pressures are normal; however, it is of markedly increased risk if pulmonary hypertension is present see Eisenmenger's syndrome. It rarely has been detected during adulthood.
Elevation of pulmonary artery pressure and potential reversal of the shunt with profound systemic hypotension pose the same risks as do septal defects. Eisenmenger's syndrome Eisenmenger's complex is the hemodynamic consequence of a shunt lesion.
Eisenmenger's syndrome occurs when an intracardiac shunt results in severe pulmonary vascular disease, increasing right ventricular pressure and causing right-to-left shunting of deoxygenated blood.
The patient becomes cyanotic and experiences digital clubbing and polycythemia. Right-to-left shunting may increase, thus worsening hypoxemia.
Later in pregnancy, termination can pose substantial risk and should be monitored carefully. Prematurity, small size, and low birth weight have been associated with the severity of maternal cyanosis.
In adults, it can be complicated by hypertension, aortic dissection, and arteritis. Coarctation of the aorta is associated with aneurysms of the circle of Willis, which may manifest as an intracranial hemorrhage. After surgical repair, patients often require antihypertensive medication, which also should be assessed before conception.
Hypertension may worsen during pregnancy and preeclampsia may occur. There have been reports of aortic dissection during pregnancy. In women of childbearing age who are asymptomatic, it is usually a less severe form of the anomaly.
Tricuspid regurgitation is commonly seen, and there may be an associated atrial septal defect or patent foramen ovale. Cyanosis can occur in adults and can worsen with exercise, fatigue, or exposure to cold Table 8. Tetralogy of Fallot Tetralogy of Fallot is the most common cyanotic congenital heart disease.
It is a complex cardiac defect that includes a large ventricular septal defect malignment typeinfundibular pulmonic stenosis, right ventricular hypertrophy, and an overriding aorta.
Prolonged Valsalva maneuvers, such as those performed during the second stage of labor, may further decrease systemic blood flow, thus favoring right-to-left shunting and worsening cyanosis.
A woman who has undergone correction and has mild residual hemodynamic abnormalities, such as tricuspid regurgitation, pulmonic stenosis, or pulmonic regurgitation, should tolerate pregnancy well.Jarvis Chapter Heart and Neck Vessels.
STUDY. PLAY. Define apical impulse and describe its normal location, size, and duration Describe the characteristics of the first heart sound and its intensity at the apex of the heart and at the base. (ex mitral stenosis or heart failure) 3. Pulmonary hypertension (ex aortic or pulmonic.
Words in science are often used in different ways from ordinary English. Completely different meanings even occur in different branches of physiology, e.g.
for the word "accommodation". which of the following characteristics applies to type 1 diabetes? a. significant hyperglycemia and ketoacidosis result from lack of insulin b. this condition is commonly dx on routine exam or workup.
Congenital heart defects can cause a right heart to left heart shunting of blood that results in increased unoxygenated blood flow Cardiac tamponade and pericardial effusion can be life-threatening when the pericardial sac _______ and ______ the heart. The pulse rate can be used to check overall heart health and fitness level.
Generally lower is better, but bradycardias can be dangerous. Symptoms of a dangerously slow heartbeat include weakness, loss of energy and fainting. Chest pain is pain in any region of the grupobittia.com pain may be a symptom of a number of serious disorders and is, in general, considered a medical grupobittia.com pain can be differentiated into heart-related and non heart related chest pain.
Cardiac chest pain is called angina grupobittia.com causes of noncardiac chest pain include gastrointestinal, musculoskeletal, or lung issues.